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This paper takes as an example of the cycle of evaluation the work of the Royal College of Radiologists in connection with the more effective use of preoperative chest X-ray. The work covers a six year period beginning with an observation of practice on a national sample in 1976, progressing to the comparison of existing practice with expectations in 1978. This was followed by the development of guidelines of practice which were disseminated informally, and formally through scientific papers and meetings from 1979. In 1981, practice was again observed in a pilot area to ascertain if the proposed guidelines had produced the desired affect. The results of this second review showed that the intentions of the guidelines had been achieved successfully, i.e. substantial reduction in utilization with considerable potential financial saving without any decrease in the original effectiveness or safety of the intervention. Thus this example shows the closing of the evaluation loop and the successful implementation of change.